COPD

Question 1

definition of COPD

Answer 1

chronic, progressive lung disorder characterised by airflow obstruction paired with chronic bronchitis and emphysema. it is not fully reversible

Question 2

how to classify chronic bronchitis

Answer 2

chronic cough AND production of sputum on most days over 3 months per year for 2 years

Question 3

how to classify emphysema

Answer 3

permanent destructive enlargement of alveoli. stretch and recoil damaged

Question 4

aetiology of COPD

Answer 4

damage to the bronchi and alveoli are mainly due to environmental toxins; primarily cigarette smoke.

causes inflammation and leads to increased goblet cells, increased mucus production and therefore leads to narrowing of the airways

Question 5

what is a rarer cause of COPD in young patients that have never smoked

Answer 5

a1-antitrypsin deficiency (alpha 1 -antitrypsin)

Question 6

pathology of chronic bronchitis

Answer 6

bronchiolitis (bronchiole inflammation) due to narrowed airways

squamous hyperplasia

mucous hypersecretion

bronchial mucosal oedema

Question 7

pathology of emphysema

Answer 7

destruction of alveoli; decreased elastin

leads to enlarged alveoli

leads to bullae (>1cm)

Question 8

main risk factors for COPD

Answer 8

SMOKING

advanced age

genetic factors

Question 9

presenting symptoms (history and exam)

Answer 9

cough, difficulty breathing, SOB, sputum production, coarse crackles, barrel chest, hyper resonance on percussion, wheezing

Question 10

why coarse crackles in copd

Answer 10

reopening of collapsed airways

Question 11

why hyper resonance in COPD

Answer 11

emphysema (air)

Question 12

signs of CO2 retention

Answer 12

bounding pulse, warm peripheries, elevated JVP

Question 13

investigations for COPD diagnosis

Answer 13

spirometry and Pulmonary functions tests,

CXR

bloods

ABG

Question 14

spirometry results for COPD

Answer 14

OBSTRUCTIVE FEATURES:

reduced FEV1/ FVC, increased lung volumes and reduced PEFR,

Question 15

CXR findings with COPD

Answer 15

hyperinflation (>6 anterior ribs)

Question 16

bloods in COPD?

Answer 16

FBC; increased Hb and PCV due to secondary polycytheamia

Question 17

treatment for COPD

Answer 17

Smoking Cessation

SABA, LABA, LAMA (bronchodilators)

steroids

pulmonary rehabilitation

oxygen therapy (88-92% sats)

Question 18

e.g. of bronchodilators

Answer 18

Salbutamol (SABA)

Question 19

e.g. of steroids

Answer 19

inhaled beclamethasone

Question 20

treating an acute exacerbation of COPD

Answer 20

24% O2 via Venturi mask

Increase slowly if no hypercapnia and still hypoxic (do an ABG)

Corticosteroids

Start empirical antibiotic therapy if evidence of infection

Respiratory physiotherapy to clear sputum

Non-invasive ventilation may be necessary in severe cases

Question 21

how to prevent infective exacerbation

Answer 21

pneumococcal and influenza vaccinations

Question 22

prognosis

Answer 22

HIGH morbidity